Professor Sarah Halligan So, PTSD was  originally thought of as a diagnosis that   affects individuals who’d been through very  extreme events. So, a classic example would   be soldiers who’d been involved in significant  combat. However, we now understand that any kind   of event that involves actual serious  harm, or the threat of serious harm,   can be a trigger for the development of PTSD.  This can, of course, include extreme experiences,   like, experiencing war, but it can also  include some relatively common experiences,   so that could be things like being involved in a  car accident, or another serious kind of accident. How objectively severe an event  is can be very hard to define,   ‘cause the experience can vary so much from  individual to individual, and it, also,   doesn’t seem to be particularly important  in predicting who will develop PTSD. One   event characteristic that is associated with  the likelihood of developing PTSD is whether   or not the event involves intentional harm by  somebody else, so something, like, for example,   being physically attacked or abused, those  kinds of intentional traumas are known to   increase the risk of developing post-traumatic  stress disorder, in children and adolescents. Most children and adolescents who experience  a trauma do not go onto develop PTSD as a   consequence. The evidence shows that among  the children and adolescents who’ve been   exposed to a trauma, the rate of PTSD is only  around 15%. Even following those higher risk,   intentional traumas, like assaults or abuse,  the estimated rates of PTSD among children and   adolescents is only around 25%. Whilst this  is really important, ‘cause it does mean a   significant number of trauma-exposed children  are affected by PTSD, I think it’s important to   also note that many children who experience  trauma will recover really well afterwards. This is incorrect, there’s good evidence  that children as young as six years of age   are at risk of developing post-traumatic stress  disorder. In younger children than six years,   it can be very hard to measure PTSD, because  very young children are not well able to   describe their symptoms. However, as far as we  are able to measure PTSD in very young children,   even those under six years of age can develop  post-traumatic stress disorders following trauma. In very young children, the signs of PTSD  might look a bit different. For example,   you might see children re-enacting the trauma  in their play, or you might see some children   losing skills they’d already developed,  so they might go back to wetting the bed,   or they might need extra support to do  things they were doing independently   before. There is some evidence that the risk  of PTSD might increase in adolescents, but,   so far, we aren’t very sure about why that  might be happening, or it’s not very clear   how significant those increases might be,  so we need more evidence on that front. It is true for the vast majority of children,  that if they’re struggling with PTSD it’s going   to be the case that it’s present immediately  following the trauma. There is a small minority   of children who don’t meet the criteria for PTSD  in a – in the first months following the event,   who will go on to develop PTSD later  on, so maybe many months later. However,   even in such cases of delayed onset PTSD, for  most children, this will be a worsening of   symptoms that were already present. So, it  would be very unusual actually for delayed   onset PTSD to be an out of the blue emergence  of problems that really weren’t there, at all. This is also incorrect. Children who are exposed  to the same, or very similar, events, can actually   respond very differently. And there are many  factors that have been identified that contribute   to differences in vulnerability to PTSD across  individuals. Some of those factors are things that   exist prior to the trauma, so, for example, girls  are more likely to develop PTSD following a trauma   than are boys. But some are factors that influence  risk of PTSD, following exposure to a trauma,   and those factors could be easier to change.  So, for example, how the child makes sense   of what happened to them, and how much support  they receive from others following the trauma,   are factors that have been linked to the later  differences in development of PTSD among children.  Parents and others do often worry that  talking about children with trauma could   trigger more serious problems, or make them more  distressed. However, as far as we understand it,   this is unlikely to happen. But it is  the case that children may vary, a lot,   in terms of how much they want, or need,  to talk about trauma. Some children may   be coping really well, and they won’t  wa – need to talk about what happened,   and they won’t want to talk about what  happened. However, some children may not   want to talk about the trauma because they find it  too distressing. If this persists in children that   otherwise seem to be struggling, this could  be a sign that they need some extra support. It’s really important that parents and others  don’t avoid conversations about trauma with   their children, or always wait for children  to initiate these. Because children can take   that as a sign the trauma talk is off limits,  and this, in turn, can limit opportunities for   parents and others to understand how the child is  getting on. So, while parents and others really   shouldn’t force children to talk about traumatic  events, it is important that they give children   clear opportunities for those conversations  about what happened, should children want them. The overall pattern for children exposed to  trauma is for the symptoms of PTSD to be at   their highest in the immediate aftermath of what  happened, and to gradually decrease over the,   kind of, three to six months that follow  exposure to trauma. However, underlying that,   there is quite a bit of individual variation.  So, around half of children who initially meet   criteria for PTSD in the short-term following  trauma will recover over this period,   but the remainder will continue to have  significant, persistent problems with PTSD. And beyond six months post-trauma, the evidence  suggests that symptoms are actually much less   likely to improve on their own over time.  So, this means that if children are really   struggling in the first months following  trauma, or are still experiencing problems   around three to six months later, they  may need treatment in order to get better. So, the NICE guidelines, which provide  treatment recommendations in the UK,   based on the available evidence, recommend  trauma-focused cognitive behavioural therapy,   or CBT, as being effective at treating PTSD in  children who are at least seven years of age. This   should usually be delivered as an individual  therapy, but it can also be effective when   delivered as a group treatment, in some settings,  or some individuals. Trauma-focused CBT will be   effective in treating PTSD for many children and  adolescents, so it’s really good news that there   are effective treatments out there for this  group. If trauma-focused CBT doesn’t work,   then another therapy, eye movement  desensitisation and reprocessing,   or EMDR, may be offered as an alternative  treatment which is also known to be effective. We don’t currently have the evidence  to support other treatments as being   effective for treating PTSD in children and  adolescents, so things like counselling,   for example. This means that if you’re  seeking help for a child or adolescent   who has PTSD, you should really try, if possible,  to ensure that they receive these evidence-based,   trauma-focused treatments that are  recommended in the NICE guidelines. Flashbacks to the trauma, when a child  feels like they’re back in the moment,   are one of the main symptoms that people associate  with post-traumatic stress disorder. However,   many individuals with PTSD will not include  full-blown flashbacks to the trauma, including   children. And, in fact, the symptoms of PTSD are,  of course, much broader than this. So, they do   include having bad memories of what happened, or  feeling very upset when reminded of the trauma,   and children are also likely to want to avoid  thoughts or reminders of what happened to them. But they could involve other wide-ranging changes,   so things like persistent negative thoughts  or feelings following the trauma, for example,   children with PTSD can find it harder to feel  happy or may experience other very strong negative   emotions. Or they might think that they’ve been  permanently damaged by what happened to them,   or think that the world is somehow very  dangerous, following exposure to the trauma. Finally, children and adolescents  with PTSD can be very jumpy, on-edge,   or more irritable and angry than they were  before, and they may have broader problems   with things like sleeping and concentrating,  again, that weren’t present before the trauma.   Not all of these symptoms are going to be visible  to other people, so it can be helpful if parents   and others ask children how they’re getting on  following a trauma, so that it can have a clear   picture of how children are doing, that includes  all of these possible manifestations of PTSD. If a child has experienced trauma and  is struggling to cope, then it’s really   best to get treated as soon as possible. This is  because if problems like PTSD are left untreated,   they can lead to other issues, like children  missing school, missing out on social experiences,   and potentially developing other mental  health difficulties. It’s been established   that psychological disorders, in  general, can be harder to treat,   if they’ve been present for a very long  time. So, for all of these reasons,   waiting a long time to get help for a  psychological disorder is never advisable.